Browsing by Author "Hesse, I.F.A."
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Item Adult tetanus in Accra, why the high mortality? An audit of clinical management of tetanus(West African Journal of Medicine, 2005-10) Hesse, I.F.A.; Mensah, A.; Asante, D.K.; Lartey, M.; Neequaye, A.Background: Tetanus is a life threatening infection relatively uncommon in the developed countries but occurs frequently in developing countries with case fatality rates of 40-60%. Recent review of adult tetanus at the Korle-bu Teaching Hospital showed a high case fatality of 50%. In order to determine the factors underlying this high case fatality we conducted a retrospective clinical audit of the clinical management of adult tetanus admitted in 1994 to 2001 to the Korle-bu Teaching Hospital. Methods: Data extracted from the admission and discharge books of the Fevers' Unit of Korle-bu Teaching Hospital, Accra and patient case notes were examined and analysed. Results: Case fatality rate (CFR) varied from 25% in 1999 to 72.7% in 2001. There was no gender difference in the case fatality. There was no significant difference in the mean age of those who died and those who survived, however, the CFR rose with age. The presence of neck and a dirty wound were associated with increased CFR. The CFR correlated with the severity of tetanus and increased when an expected treatment action, wound debridement, administration of antibiotics and/or immunoglobulin, was not performed. The administration of anti-tetanus toxin was associated with an increased CFR. Conclusion: The high case fatality rate in Accra was due to inappropriate management with most of the patients not treated with immunoglobulin and antibiotics and had inadequate wound care.Item Case of Culture Proven Multi-Drug Resistant Tuberculosis in Ghana.(Ghana Medical Journal, 1997) Hesse, I.F.A.The factors which lead to multi-drug resisl.t1.nt tuberculosis arc present in Ghana yet no case has been reported in Ghana. 1\ case of culture proven multidrug resistant tuberculosis is described. This patient was managed in the previous era of tuberculosis programme when he was treated for over a decade with varying and inappropriate drug prescribing pattern. erratic supply of drugs, poor compliance and introduction to all the drugs in the anti -TB armamentarium. Despite recent intensive directly observed and supervised therapy with streptomycin. rifampicin. ethambutol, pyrazinamide and isoniazid he did not clinically improve. Sputum culture and sensitivity grew Mycobacterium tuberculosis resistant to ethambutol. isoniazid. rifampicin and streptomycin.Item Characteristics of adult tetanus in Accra(West African Journal of Medicine, 2004-03) Hesse, I.F.A.; Mensah, A.; Asante, D.K.; Lartey, M.; Neequaye, A.Background: Tetanus is a life threatening infection with an estimated annual global incidence of about 1 million cases and a mortality of 50%. It is very common in developing countries. The prevalence in Ghana is not known, however, cases continue to be admitted in hospitals in the country. This retrospective study was undertaken to define the characteristics of cases of tetanus in adults admitted to the Korle-bu Teaching Hospital, Accra, Ghana, from 1 January 1994 to 31 December, 2001. Methods: Information was extracted from the admission and discharge registers of the Isolation Unit of Korle-bu Teaching Hospital, Accra and case notes were examined and analysed. Results: There were 158 (76.6%) males) cases of tetanus with mean age of 32.7 ± 15.0 years. The peak age was in the 20-29 year group. Admission rate was lowest during the raining season months of June-August. Traumatic injury occurred outdoors (56.9%) and was caused by deep prick (24.3%), or cut (16.2%). The most common site of injury was on the lower (44.6%) limbs. The time interval between injury and admission was 8.3 ± 22.4 weeks (range 1-156 weeks) and the duration of symptoms was 2.9 ± 2.7 days (range 1.0-21.0 days). The most common presenting features were locked jaw (82.4%), general spasm (62.2%), presence of a wound (53.7%) and neck stiffness (50.0%). Hospital admission was 11.4 ± 11.6 (range 0-53) days. The case mortality was 50% (79/158). Conclusion: These results confirm that adult tetanus is still very prevalent in Ghana and is occurring in a younger age group compared to that in the developed countries. The case mortality is still very high.Item Clinical audit of management of asthma in children at Korle Bu teaching hospital(Ghana Medical Journal, 2003-09) Goka, B.Q.; Hesse, I.F.A.; Oliver-Commey, J.O.Asthma is now recognized as an important childhood Illness in developing countries. Unnecessary morbidity and mortality are caused by lack of recognition and inadequate treatment of asthma, All audit of the management of children with acute asthma admitted to the Karle Bu Teaching hospital was conducted with the view of making recommendations for the improvement of patient care The case notes of patients \1ho had suffered at least 3 episodes of breathlessness and Wheeze were inspected to assess the drug history, clinical evaluation of the severity of the al1ack. investigations requested and medications prescribed. There were 102 admissions. A drug history was recorded for 60 (58 .8%) admissions. Chest auscultation findings were documented for 98 (96.1%) patients and the ability to complete sentences for 10 (9.8%), The peak expiratory flow rate was not measured for any of the patients. Drugs had to be bought by parents/guardians for 16 (16.3%) admissions before the treatment could be initiated. Treatment was delayed for more than 30 minutes III 20 (20.6%) patie1lls, Nebulised salbutamol and systemic steroids were prescribed for 98 (96, 1 %) and 55(53.80%) patients, respectively. The results showed that the assessment ,and treatment of patients was inadequate and recommendations for improvement are made.Item Determinants of Arterial Blood Pressure in Urban Ghanaians: Plasma Renin Activity and Sodium Balance(University of Ghana, 1997-10) Armah, A.P.; Hesse, I.F.A.; University of Ghana, College of Health Sciences, School of Biomedical and Allied Health Sciences, Department of PhysiologyIn the tropics, prevailing weather conditions exert a tremendous influence on fluid and electrolyte homeostasis of residents. For the tropical resident, who may have evolved an adaptive strategy to conserve sodium and water by renal and hormonal mechanisms, increases in sodium intake may cause changes that would, in the long term, lead to an increase in the arterial blood pressure. In this study, three serial protocols were followed to elucidate the significant role of sodium balance and the regulatory renin-angiotensin system in determining the arterial blood pressure of urban resident Ghanaians, and as a basis to explain the recent observed increase in the prevalence of hypertension in Ghana. The first series of the investigation showed a rising trend in the arterial blood pressure with advancing age for 31 randomly selected subjects; a phenomenon associated with populations on a high salt diet. In the second series, low levels of plasma renin activity (mean = 0.71 ± 0.13 pmol Ang. I/ml/hr) were obtained in 10 subjects (8 normotensive and 2 hypertensive). Such low levels of plasma renin activity, signifying a suppressed renin-angiotensin system, is also associated with a high salt intake. Finally, the last series on 11 subjects, who were fed ad lib, revealed a high intake of sodium (mean = 295.2 ± 9.0 mmol) at a threshold of 300 mmol above which the subjects could not effectively excrete any extra sodium load. The significance of such findings, albeit using different subject groups and a small sample population, is that sodium homeostasis can be considered as a major determinant of arterial blood pressure of tropical residents. Given the present recognition of sodium (salt) as an environmental stressor, and considering its ready availability, accessibility and affordability, high intakes, as observed in this study, could lead to elevation of the blood pressure. This may set the stage for explaining the recent observations regarding the increase in prevalence of hypertension in Ghana.Item Knowledge of asthma and its management in newly qualified doctors in Accra, Ghana(Respiratory Medicine, 1994-03) Hesse, I.F.A.This study assessed first-year doctors’ (House Officers) knowledge of asthma at the Korle-Bu Teaching Hospital. Seventy-two out of 80 doctors answered 32 questions on various aspects of asthma. Many of these doctors managed between one to three asthmatics per week. Few, however, did so by acceptable standards. In assessing the severity of asthma, 88% looked for cyanosis, 69% looked for pulsus paradoxicus and 63% looked for a fast pulse rate. Only 63% considered the measurement of peak expiratory flow useful. Ninety-four per cent used intravenous aminophylline, 82% intravenous hydrocortisone and 14% oxygen as the drug of choice for acute severe asthma. In moderate forms of acute asthma, 54% used salbutamol inhaler or intravenous aminophylline, 28% oxygen, 15% steroid inhaler and 14% oral prednisolone. Nebulized bronchodilators are not well known for use in either severe or moderate asthma and only 19-21% of doctors had prescribed their use. In chronic asthma, 55565% of respondents prescribed bronchodilators compared to 19-35% who gave anti-inflammatory drugs. These results reveal insufficient knowledge of the pathophysiology of asthma, the use of standard drugs in asthma therapy and international guidelines for the management of asthma. The results also show that the pragmatic constraints which exist in developing countries preclude the adoption of international guidelines without local modification.Introduction Asthma is now recognized to be due to chronic inflammation of the airways. There is evidence of inflammation even in patients with mild forms of the disease (1). This current view of the pathophysiology of the disease has altered the traditional methods of management. Internationally, the rationale of management is primarily to reduce inflammation. Anti-inflammatory drugs are generally preferred to bronchodilators in modern practice (2). The disease still has a significant morbidity and mortality which may increase worldwide despite the availability of potent drugs. Among the major factors which contribute to the morbidity and mortality of asthma are under-diagnosis and under-treatment by medical personnel and patients (3-5). Factors related to the availability of health care are also major contributors (6,7). In Third World countries where hospital facilities are inadequate and where current information about management may not be readily available, morbidity and mortality are expected to be even higher. Lack of knowledge of the pathophysiology of asthma has also contributed to the morbidity and mortality of the disease. To reduce mortality andparticular, education of health personnel and even of patients on principles of the management of asthma is essential (8). This need has, indeed, been emphasized in the international guidelines for assessment and treatment of asthma (2). In Ghana, bronchial asthma is well known and commonly encountered in clinical practice. However, very little systematic work has been done to establish its prevalence and the level of mortality. It is also important to determine the level of knowledge of practising doctors in Ghana of the disease and its management. The present study focuses on recently qualified doctors who, presumably, have current knowledge of the management of asthma from recent medical school training. A reason for choosing this group is that House Officers are first-in-line for the management of emergencies including asthma. Management problems are more likely to be associated with this group. Methods Seventy-two out of 80 House Officers (aged 25-32 years) at the Korle-Bu Teaching Hospital (KBTH) in Accra participated in this study. KBTH is the primary referral centre in Ghana. It has a bed capacityof 1700, and is the main hospital for training students from the University of Ghana Medical School. House Officers involved in this study had worked in the KBTH for up to 12 months after graduation from medical school. They included doctors trained at the University of Ghana Medical School, the School of Medical Sciences, Kumasi and a number from schools outside Ghana.Each respondent answered 32 questions on various aspects of asthma, including its management. Some of the questions demanded multiple responses to determine degree of knowledge.Item Prevalence of antibodies to human T-Iymphotropic virus type I among blood donors in Accra, Ghana(Ghana Medical Journal, 2003-09) Adjei, A.A.; Adiku, T.K.; Ayeh-Kumi, P.F.; Armah, H.; Ansah, J.; Hesse, I.F.A.Several infectious diseases have been found to be associated with transfusion of blood or blood components. Reports from studies conducted in many African countries indicate high incidence of blood-borne pathogens such as human Tlympholropic virus type-I ( HTLV- I) infections among healthy blood donors. The prevalence of HTLV- I antibodies in blood donors in Ghana is not well documented. This study was therefore conducted to determine the prevalence of HTL V- I antibodies among blood donors seen between the months of June and July 2001 at the National Blood Transfusion Service. Accra Area Centre (Blood Bank) at the Korle Du Teaching Hospital, Accra, Ghana. The presence of antibodies specific for HTLV-I was tested using particle agglutination test kit. of the 265 sera tested . 220 (83%) were males and 45 (17%) were females. A seroprevalence rate of 4.2% (11/265) was found. The prevalence rate of antibody to HTL V·I was significantly (PItem Prevalence of human immunodeficiency virus infection among tuberculosis suspect patients in Accra, Ghana.(West African Journal of Medicine, 2006) Adjei, A.A.; Adiku, T.K.; Ayeh-Kumi, P.F.; Hesse, I.F.A.BACKGROUND: Acquired immunodeficiency syndrome is a major public health concern worldwide, particularly in Ghana, where recent reports indicate an increase of the disease. A close association between infection with human immunodeficiency virus (HIV) and tuberculosis (TB) is well known. A previous study showed a 16.8% seroprevalence of HIV in TB patients on admission at the chest clinic of the Korle-Bu teaching hospital. However this was in severely ill patients on admission and there was a likely selection bias. This study was therefore designed to determine the prevalence of HIV infection among patients suspected of TB attending the laboratory of the chest clinic of the Korle-Bu Teaching hospital, Accra, Ghana. METHODS: Pulmonary TB was diagnosed using clinical, sputum smear microscopy and chest x-ray features. HIV was determined using particle agglutination test (HIV-1 and HIV-2) and synthetic peptide-based immunoassay (Peptilav I and II ELISA). RESULTS: Of the 277 subjects examined, 108 (39%) were diagnosed as TB. The seroprevalence of HIV was 46.2% in all TB suspect patients. It was 47.2% and 45.6% in those with and without tuberculosis, respectively. in both groups, the peak age distribution of subjects positive for HIV antibodies was from 20 to 59 years. CONCLUSION: The results show a great increase in HIV seroprevalence in TB patients in Korle-Bu. The high HIV seroprevalence suggests that subjects suspected of TB should be tested for HIV as well.Item Prevalence of human Immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis among prison inmates and officers at Nsawam and Accra, Ghana(Journal of Medical Microbiology, 2006) Adjei, A.A.; Armah, H.B.; Gbagbo, F.; Ampofo, W.K.; Quaye, I.K.E.; Hesse, I.F.A.; Mensah, G.Although the high prevalence of blood-borne viral infections and syphilis in correctional facilities has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study sought to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among prison inmates and officers at prisons in Nsawan and Accra, Ghana. Prisoners and officers in 3 of the 46 prisons in Ghana were surveyed from May 2004 to May 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HIV, HCV and Treponema pallidum, the causative agent of syphilis, and the surface antigen of hepatitis B virus (HBsAg). Almost 16% (3770) of the total of 23,980 prison inmates in Ghana were eligible, and 281 (7.5%) of those eligible took part, whilst almost 23% (1120) of the total of 4910 prison officers were eligible, and 82 (7.3%) of those eligible took part. For the 281 inmates tested, HIV seroprevalence was 19.2%, 17.4% had HBsAg, HCV seroprevalence was 19.2% and reactive syphilis serology was noted in 11%. For the 82 officers tested, HIV seroprevalence was 8.5%, 3.7% had HBsAg, HCV seroprevalence was 23.2% and reactive syphilis serology was noted in 4.9%. The data indicate a higher prevalence of HIV and HCV in correctional facilities (both prison inmates and officers) than in the general population in Ghana, suggesting their probable transmission in prisons in Ghana through intravenous drug use, unsafe sexual behaviour and tattooing as pertains to prisons worldwide.